This is one of many reviews on this topic but it's not just any review. It is the most thorough examination of the pathopysiology I've seen in a long time. Read it when you're well rested and well fed. Two or three times.
Via Medscape. CME available.
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I have been practising for quite a while, and have always thought of myself as pretty familiar with hyponatremia.
Now there is a recurrent clinical scenario which has foxed me. Patients with cancer often present with altered mental status, with hyponatremia, maybe between 110 - 120. Not a surprise. Inevitably, a sodium chloride infusion is started prior to the lab work coming back, which suggests SIADH, except for the fact that some clinical improvement certainly takes place, which would not be suggestive of SIADH. Now after a day or so, this sodium plateaus at around 120 - 125, with the patient out of confusion. A repeated work-up still suggests SIADH. Some further improvement is seen on fluid restriction at this point.
It is a little puzzling. Is this really dehydration superimposed on (mildly hypervolemic thermostat) SIADH?
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